April 2013 TAKING THE PULSE: WHAT KENYAN PRESIDENTIAL CANDIDATES PROMISED ON HEALTH AND WHY IT MATTERS This publication was prepared by the Health Policy Project. HEALTH POLICY PROJECT Suggested citation: Health Policy Project/Kenya. 2013. Taking the Pulse: What Kenyan Presidential Candidates Promised on Health and Why it Matters. Washington, DC: Futures Group, Health Policy Project. The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. It is implemented by Futures Group, in collaboration with CEDPA (CEDPA is now a part of Plan International USA), Futures Institute, Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). Taking the Pulse: What Kenyan Presidential Candidates Promised on Health and Why It Matters APRIL 2013 This publication was prepared by the Health Policy Project. The information provided in this document is not official U.S. Government information and does not necessarily represent the views or positions of the U.S. Agency for International Development. CONTENTS Abbreviations ........................................................................................................................... iv Introduction ............................................................................................................................... 1 Current Health Sector Policy Priorities in Kenya ...................................................................... 2 2013 Presidential Candidates: Plans and Pledges for the Health Sector .............................. 3 Overview of Results ................................................................................................................................... 3 Organisation of Service Delivery System to Maximise Health Outcomes ................................................. 5 Leadership and Governance to Deliver on the Health Agenda .................................................................. 6 Human Resources for Health ..................................................................................................................... 6 Health Financing: Efficient Mobilisation, Allocation, and Utilisation ....................................................... 7 Adequate and Appropriate Health Infrastructure ....................................................................................... 8 Health Information, for Evidence-Based Decision Making ....................................................................... 8 Universal Access to Essential Health Products and Technologies ............................................................. 8 Conclusion: Keeping the Promises .......................................................................................... 8 References ............................................................................................................................... 11 Appendix I: Summary of Pledges by Strategic Area ............................................................ 12 Appendix II: Jubilee Coalition Pledges on the Health Sector .............................................. 18 Appendix III: Kenya’s Two-Tier Health Management System .............................................. 19 iii ABBREVIATIONS ARC Alliance for Real Change CORD Coalition for Reform and Democracy KEMSA Kenya Medical Supplies Agency KHSSP Kenya Health Sector Strategic Paper KNC Kenya National Congress KShs Kenya Shillings NHIF National Health Insurance Fund ODM Orange Democratic Movement RBK Restore and Build Kenya (Party) TNA The National Alliance UDF United Democratic Front INTRODUCTION The 2013 general election in Kenya took place on 4 March 2013, giving citizens a chance to elect new leaders for a five-year term. The elections were the first to be held under the new Constitution passed in 2010, which introduced a devolved system of government that operates on two tiers: the national and the county. For the first time, Kenyans had to pick candidates for six different types of leader on their ballots: the president, county governors, senators, members of Parliament, women representatives to Parliament, and civic ward representatives. The run-up to the elections saw major realignments in the political landscape of the country, including the formation of coalitions of parties to increase their respective candidates’ influence and odds of winning. The leading parties and coalitions fielded eight presidential candidates, the largest field Kenya has ever recorded. Candidate Running Mate Coalition Party 1. Mohammed Joshua Odongo – Alliance for Real Change Abduba Dida (ARC) 2. Raila Odinga Kalonzo Coalition for Reform and Orange Democratic Musyoka Democracy (CORD) Movement (ODM) 3. Uhuru Kenyatta William Ruto Jubilee Coalition The National Alliance (TNA) 4. Musalia Mudavadi Jeremiah Ngayu Amani Coalition United Democratic Front Kioni (UDF) 5. Martha Karua Augustine – NARC-Kenya Lotodo 6. Peter Kenneth Ronald Osumba Eagle Alliance Kenya National Congress (KNC) 7. James ole Kiyiapi Winnie Kaburu – Restore and Build Kenya (RBK) 8. Paul Muite Shem Ochudho – Safina During the campaign period, the leading contenders and their parties took positions on various issues of national interest. A prominent feature of the campaigns was the launch of party manifestos or other policy statements on different voter concerns. In some cases, these launches were high-profile public events, while some parties simply included statements about their priorities in public speeches and discussions and on websites. Party manifestos and other public declarations are key instruments that reflect what a party and its candidates’ policy and programmatic priorities would be if elected. However, in a bid to win voters, position papers, manifestos, and related documents as well as candidates’ public utterances can sometimes be embellished with unrealistic promises. Some manifestos may also be too vaguely worded to be binding. 1 Taking the Pulse: What Kenyan Presidential Candidates Promised on Health and Why It Matters This brief looks at the pledges, commitments, and promises made by the 2013 presidential candidates about the health sector in Kenya. It examines what the candidates and their parties promised to do about different health issues, and how these promises align with current health sector aspirations outlined in the government’s existing short- and long-term policy and planning documents. The goal is to provide stakeholders in the health sector with a reference point from which to hold the incoming government accountable on its public promises, and a tool for advocacy in pursuing further commitments that can improve the public health sector. CURRENT HEALTH SECTOR POLICY PRIORITIES IN KENYA To help achieve the overall goal of “attaining the highest possible standard of health in a manner responsive to the needs of the population,” the Kenya Health Policy 2012–2030 (Ministry of Medical Services and Ministry of Public Health and Sanitation, 2012) has the following objectives: • Eliminate communicable diseases • Halt and reverse the rising burden of noncommunicable diseases • Reduce the burden of violence and injuries • Provide essential healthcare • Minimise exposure to health risk factors • Strengthen collaboration with other sectors that have an impact on health The policy further outlines seven policy orientations, which define how the objectives will be met and where investments will be made in the 2012–2030 period. These are • An efficient service delivery system that maximises health outcomes • Comprehensive leadership that delivers on the health agenda • Adequate and equitable distribution of human resources for health • Adequate finances mobilised, efficiently allocated, and used • Adequate health information, for evidence-based decision making • Universal access to essential health products and technologies • Adequate and appropriate health infrastructure These seven policy orientations are further elaborated in the draft Kenya Health Sector Strategic Plan 2013–2017 (KHSSP) (Government of the Republic of Kenya, 2013a). Kenya’s priorities in health are also informed by the country’s development blueprint, Kenya Vision 2030 (Government of the Republic of Kenya, 2007). The strategy identifies three pillars that form the foundation of Kenya’s development: the economic pillar, the political pillar, and the social pillar, under which health falls. Strategies to improve healthcare under the social pillar include providing a robust health infrastructure network countrywide, improving the quality of health service delivery to meet the highest standards, and providing an equitable health financing mechanism to give access to those who have been excluded from healthcare for financial or other reasons. Kenya Vision 2030 also identifies specific projects (flagship projects) that are expected to lead to rapid transformation in the health sector. These projects are • Rehabilitating health facilities, including rural facilities, to offer integrated and comprehensive healthcare • Strengthening the Kenya Medical Supplies Agency (KEMSA) 2013 Presidential Candidates: Plans and Pledges for the Health Sector • Developing a human resource strategy • Developing an equitable financing mechanism • Implementing community-based information systems • De-linking the Ministry of Health from service delivery • Fast-tracking